ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China.
Mucosal Melanoma Treatment Center, Eye and ENT Hospital, Fudan University, Shanghai, China.
J Otolaryngol Head Neck Surg. 2024 Jan-Dec;53:19160216241267737. doi: 10.1177/19160216241267737.
To explore the prognostic factors in patients with advanced olfactory neuroblastoma (ONB) underwent endoscopic surgery.
Retrospective medical records were reviewed of patients with pathologically proven ONB who underwent endoscopic surgical resection. Clinicopathological characteristics including patient demographics, treatment, complications, follow-up, and outcomes were analyzed. Kaplan-Meier overall survival (OS) and disease-free survival (DFS) curves were plotted. Univariate and multivariate Cox regression models were used to determine prognostic factors.
Eighty-five patients with Kadish stage C ONB were examined. According to the various staging systems used, most patients harbored modified Kadish stage C (78.8%). Twenty-six patients (30.6%) underwent bony skull base resection, 11 (12.9%) underwent dura resection, and 24 (28.2%) underwent additional intracranial resection that included the olfactory bulb and duct. Median follow-up was 39 months. Five-year OS and DFS rates were 83.7% and 74.9%, respectively. Five-year OS was 100% in patients treated with bony skull base resection and 77.5% in those who were not ( = .052). Dura resection did not improve OS. Multivariate Cox regression analysis identified perioperative complications ( = .009), gross total resection ( = .004), orbital invasion ( = .014), postoperative radiotherapy ( = .030), and bony skull base resection ( = .019) as independent prognostic predictors.
For patients with advanced ONB, endoscopic surgery in conjunction with radiotherapy and chemotherapy is effective and safe. Dura resection should be performed with caution in selected patients to balance survival and complications. Postoperative radiotherapy is important to improve OS and DFS.
探讨内镜手术治疗晚期嗅神经母细胞瘤（ONB）患者的预后因素。
回顾性分析经病理证实的 ONB 患者行内镜手术切除的病例。分析患者的临床病理特征，包括人口统计学特征、治疗方法、并发症、随访和结局等。绘制 Kaplan-Meier 总生存（OS）和无病生存（DFS）曲线。采用单因素和多因素 Cox 回归模型确定预后因素。
共检查了 85 例 Kadish 期 C 期 ONB 患者。根据使用的不同分期系统，大多数患者为改良 Kadish 期 C（78.8%）。26 例（30.6%）患者行颅骨底切除术，11 例（12.9%）行硬脑膜切除术，24 例（28.2%）行额外的颅内切除术，包括嗅球和嗅束。中位随访时间为 39 个月。5 年 OS 和 DFS 率分别为 83.7%和 74.9%。行颅骨底切除术患者的 5 年 OS 率为 100%，未行颅骨底切除术患者的 5 年 OS 率为 77.5%（ = .052）。硬脑膜切除术不能提高 OS。多因素 Cox 回归分析确定围手术期并发症（ = .009）、大体全切除（ = .004）、眶内侵犯（ = .014）、术后放疗（ = .030）和颅骨底切除术（ = .019）为独立的预后预测因素。
对于晚期 ONB 患者，内镜手术联合放化疗是有效且安全的。在选择患者时应谨慎行硬脑膜切除术，以平衡生存和并发症。术后放疗对提高 OS 和 DFS 非常重要。
